Practice takes some big steps toward boosting efficiency

Three new initiatives target spending, collections, workflow

Catering is one area where Yale Medical Group may be able to cut costs by leveraging its collective bargaining power.

With the largest components of health care reform kicking in at the start of 2014—and CEO Paul Taheri, MD, providing Yale Medical Group (YMG) with new leadership—the practice is taking steps to strengthen its position as a provider of choice. It is launching three new initiatives this month to reduce spending, improve collections and streamline workflow.

“We are all in this together,” said Cynthia Walker, Yale School of Medicine deputy dean of finance and administration, who is leading the initiatives with Fred Borrelli, COO of YMG. “We must begin to see ourselves as a faculty practice, not just individual doctors or departments as we have been accustomed to doing in the past. We can optimize our collective whole to support the common goal of these three initiatives, which is to create a consistent, efficient, high quality experience for physicians, staff and patients.”

Cynthia Walker

Practices to maximize collections

One initiative will take more than a year to realize fully, but it has the potential for a significant financial benefit to the practice. Yale School of Medicine has retained a group from Huron Consulting with decades of expertise in maximizing clinical revenues. Their data analysis indicates that YMG can recover up to $10 million a year that it is currently losing to duplication of effort and other inefficient collection practices.

The Huron project will identify consistent, repeatable procedures that everyone who contributes to the clinical revenue process can follow to maximize collections. “We have an obligation to make this workflow as efficient as possible,” said Walker. “At the end of the day, we want the physicians to be paid for services as they are entitled.”

Cutting down on non-salary spending

A second initiative is aimed at spending reductions in non-salary discretionary areas. It includes promoting consistent use of preferred venders in such areas as catering, equipment, maintenance contracts, travel and temporary help. “We have a lot of strength in our size, and that strength leads to cost discounts that we currently don’t maximize,” said Borrelli. “We have to leverage our collective bargaining power in purchasing.”

An institution that Borrelli worked for previously mandated the use of their dining service for all institutional events after the service committed to providing the best prices and highest quality and service in return. This worked well and kept funds in-house, he said. While Yale generally avoids mandating use of specific venders, it is finding that there are tremendous cost-savings opportunities that it is missing when different departments regularly use a variety of venders at different price points, said Borrelli.

“One opportunity that we should explore is using our own service, Yale Catering,” Borrelli said. “I have attended events catered by Yale dining recently where the food was excellent,” added Walker.

Fred Borrelli

Practice performance

Finally, YMG is also working with Huron to optimize how the practice provides patients, as well as physicians and staff, with consistent experiences. For patients, that means consistent service in everything from how they are greeted at the desk to the quality of attention they receive from their physicians. “We’ve been addressing our approach to patients in a decentralized way, but that’s not sustainable and it’s not ideal. You can see the inconsistencies reflected in our patient satisfaction scores,” Borrelli said.

Part of this initiative will involve harnessing the Epic electronic medical record (EMR)’s power to provide a more accurate picture than ever before of the way patients, staff and physicians navigate the care continuum. Borrelli expects targeted use of the EMR to lead to a reduction for staff in such manual work as scanning, faxing and documenting. “We want to maximize the use of the EMR with a focus on making our employees’ work more patient-centric, fulfilling and rewarding,” Borrelli said.

Changes are for the better

The three initiatives will mean changes for the practice, but Borrelli and Walker expect the results to be positive. “This is not a short-term effort. These are things that will change our culture and our mindset,” said Borrelli. “Changes like these will position us well not only for today, but for the future.”

As they work on the initiatives, Borrelli and Walker will be tracking the results and reporting on progress through the next several months.